# Robotic distal pancreatectomy using two-surgeon technique (TAKUMI-4): a technical note and initial outcomes

## TL;DR

This paper introduces a two-surgeon technique for robotic distal pancreatectomy and reports successful initial outcomes.

## Contribution

The novel two-surgeon technique improves standardization and safety in robotic distal pancreatectomy.

## Key findings

- Median operative time was 214 minutes with minimal blood loss and short hospital stay.
- 84.4% of patients achieved textbook outcomes using the two-surgeon technique.
- Robotic distal pancreatectomy showed superior outcomes compared to laparoscopic methods.

## Abstract

With the increasing use of minimally invasive distal pancreatectomy, the use of robotic distal pancreatectomy (RDP) is also increasing worldwide. Standardized surgical protocols are essential for safe implementation of RDP. In this study, we present our surgical protocol and initial outcomes of RDP using “two-surgeon technique”.

Our standard RDP protocol included a two-surgeon technique for cooperation, rationality, and education. Short-term outcomes of RDP were also investigated. This retrospective study included 77 consecutive patients who underwent RDP at our institution between April 2021 and January 2025.

The median operative time, estimated blood loss, and postoperative hospital stay were 214 min (interquartile range [IQR], 176–253), 10 mL (IQR, 0–50), and 9 days (IQR, 8–10), respectively. A textbook outcome was achieved in 84.4% of patients. Moreover, superior outcomes of RDP (n = 77) compared with those of laparoscopic distal pancreatectomy (n = 62) were confirmed in this study.

Using the two-surgeon technique, we successfully standardized and introduced the RDP program. The two-surgeon technique can contribute to the safe introduction of RDP and expansion of the program.